Case Management: Assessment & Implementation
The Case: Prowers Medical Center, Lamar, CO
The Challenges
The case management challenges faced by Prowers Medical Center’s leadership were great.Not only was the hospital’s entire CM team in need of training and education, but it was struggling under a CM director who didn’t want to move forward. In addition, the hospital didn’t have a Utilization Review Committee – a requirement of CMS
Q Solutions
QHR began by assessing Prowers’ entire case management function. Next, it recommended and helped implement improvements. Specifically, the hospital’s QHR team:
- Provided in-depth, hands-on training and education for all CM staff
- Streamlined all CM policies and procedures, and helped develop a new filing system to improve effi ciencies
- Established a daily work flow, which helped CM staff determine their priorities based on the types of patients in-house each day
- Established a chart review process to ensure medical necessity and determine that patients were where they needed to be
- Developed forms for social services assessments
- Assembled a Utilization Review Committee
- Put metrics in place to determine set outcomes
The Outcome
Since implementing QHR’s case management solutions, Prowers Medical Center has experienced:
- An increase in swing bed stays by approximately 400 days. This has increased net revenue by nearly $500,000 for the 25-bed hospital. A significant decrease in observation stays, which can mean reduced costs for patients
- Improved communications between the CM staff and hospital physicians, resulting in greater awareness of patient status
- Improved customer satisfaction, resulting from streamlined processes and improved communication
“Thanks to QHR, our case management team is more actively involved with both patients and their families. The improved communication has led to increased patient satisfaction. The new policies and procedures have also helped improve the working relationships between the CM staff and physicians. Our doctors now realize that case management is here to help them. Increasingly, they’re seeing CM as a resource.”
